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ASC Governance

Apr 18
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ASC Investors

ASC Investors, Your Management Company May Be Able to Save You Money on Your Personal Income Tax

By ASC Governance No Comments

A recent federal tax code ruling[1] concluded an ambulatory surgery center (ASC) investor, who has no direct management responsibilities, can exempt their ASC investment income (distributions) from self-employment tax.

The investor, Dr. Stephen P. Hardy, a pediatric reconstructive plastic surgeon in Montana, challenged the tax court with regards to his distribution income from the ASC.  He stated he was entitled to treat it as passive income due to his non-involvement in any management or operational support.

Hardy argued his primary income came from his private practice and he is only a minor investor (12.5%) in the ASC. He indicated he is not involved in the ASC’s day-to-day management responsibilities.  However, he has input on the procedures he performs in the facility.  Further, he stated he does not make management decisions.  Decision-making is left up to the management team. He also confirmed his role has not changed since he started performing procedures at the ASC.

Hardy underscored he has no obligation to perform surgical procedures at the ASC and the number of cases he brings to the facility have no bearing on his distributions. Therefore, his investment should be considered passive.

His argument held and an opinion granted by the tax court concluded Dr. Hardy’s ASC distribution income is not subject to self-employment tax. However, they have not yet established if he may deduct any passive activity loss carryover from prior years.

This tax ruling is significant for ASC partners who are self-employed.  Most ASC investors are subject to a 13.85% tax on their ASC distributions when claimed as ordinary self-employment income.  For ASC investors who employ an outside management company, or are not directly involved in the day-to-day management functions of the ASC, this income is exempt.  Check with your accountant to determine if this new IRS event positively impacts you.

Rick DeHart – Principal Partner

[1] Stephen P. Hardy & Angela M. Hardy, Petitioners v. Commissioner of Internal Revenue, Respondent. http://ustaxcourt.gov/UstcInOp/OpinionViewer.aspx?ID=11088

Apr 06
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ASC Team

Harnessing the Power of Your ASC Team

By ASC Governance, ASC Management, Leadership No Comments

Organizations who harness the power of teamwork thrive.  You can sense their vibrant energy the minute you step through their front door.  Positive momentum permeates every aspect of their business.  Their collaborative spirit is infectious.        

Teamwork in your ASC can easily make the difference between your place of business being merely another place to work or a workplace of choice.  It can also make the difference between your ASC being yet another place to receive care or the preferred patient option for ambulatory surgical services. 

ASC leaders who understand who makes up their team and what allows for a dynamic work environment are better equipped to harness the power of their team.

The diagram above is a visual representation of an ASC’s stakeholders.  Let’s explore how to engage individual team members to create a vibrant team.

What is Important to the team?

Whether an ASC is in the planning stages, has recently opened, or is in its tenth year of operation, the organization’s mission statement is critical to developing and maintaining its goals.   It serves as the cornerstone of the ASC’s culture. 

A properly crafted mission statement –

  • Communicates the purpose of the organization
  • Serves as a filter to separate what is, and is not, important to the organization
  • Clearly states which markets the organization will serve and how
  • Communicates a sense of intended direction to the entire organization

The mission statement guides the actions of the ASC, articulates its overall goals, provides a path to achieve those goals, and ensures decision-making is in keeping with those goals.  It provides the framework to develop the company’s strategies.

When crafting a mission statement, consider –

  • Quality and consistency
  • Customer service
  • Diversity and individuality
  • Professionalism
  • Specific ideals of a sponsoring or partnering health system or organization

Although it is not uncommon for a mission statement to remain the same over time, it should not remain static due to inattention or apathy.  Markets, goals, leadership, and organizations change and evolve.  Review your mission statement on a regular basis to ensure it reflects any substantial changes.

The Team

Physicians

As I have discussed in other posts, physicians become members of ASCs for a variety of reasons. Ensure you recruit physicians based on how they will function as part of your team. Careful selection is the key to success. If physicians participate for the right reasons and their previous track record demonstrates they are “team players,” integrating them into your team should not be difficult.

Because physicians interact daily with your patients and staff, it is critical for them to buy into, and actively support, the ASC’s mission and culture.  There is no quicker way to undermine the effectiveness of your workplace than to work with physicians who do not respect your organization’s purpose.

Board of Managers

Ideally, the ASC’s Board of Managers (BOM) should create the facility’s mission statement, be involved in its regular review, and develop any revisions.  By setting the facility’s policies and procedures, hiring its medical director and management team, and crafting the mission statement, the BOM is the de facto owner of the ASC’s culture.

BOMs facilitate team dynamics when they are comprised of a diverse group of investors, representing different physician groups and specialties.  When the facility is joint ventured, it is important to include hospital executive representation on the BOM.

Ultimately, the most important characteristic for board members to possess is a willingness to participate and devote the time necessary to enthusiastically engage in facility-related discussions. Board members who stay informed about facility performance and operations and consider the perspectives of all stakeholders regarding ASC topics make sound business decisions.

Medical Director

The medical director is selected by the BOM.  As with physicians, this selection needs to be based on the individual’s track record of being a “team player.” Initially, the medical director will be involved in developing the ASC’s policies and procedures.

Most importantly, the medical director is charged with supporting clinical and administrative staff, enforcing policies and procedures (along with the BOM), and effectively maintaining the facility’s culture.  This will include addressing professional issues related to physicians and staff that are averse to the desired team environment.  The medical director will also function as a team member in multiple operational areas including scheduling, staffing, inventory, operating room utilization, etc.

Clinical and Administrative Staff

A popular saying is, “Hire the right people and get out of their way.”  This holds true not only for employee skill sets and work ethic, but also for their ability to effectively function as members of a team.  Educating staff about the ASC’s mission and the BOM’s commitment to that mission sets the stage for a well-informed team ready to fulfill the desired expectations.

It is critical to support and empower clinical and administrative staff to take action and make the decisions necessary to fulfill the ASC’s mission.  For example, they must feel comfortable reaching out to ASC leadership when quality of care or customer service issues are being compromised.

As new team members are added through growth or attrition, ensure a consistent message is relayed by the physician owners, BOM, medical director, and the facility’s management team. This will ensure the desired team dynamic is preserved.

Management

Management is comprised of the ASC’s administrator and their team of program leaders.  The role of management is to own the ASC’s mission and consistently promote that message to all team members in the facility.  This is the responsibility the BOM entrusts to the center’s management. Management accomplishes this by expecting, promoting, and modeling excellent working interactions among all stakeholders.  Recognizing the contributions of all team members in pursuit of the ASC’s goals and carrying out its mission allows a team atmosphere to flourish.  

Finally, management is responsible for ensuring team members who are not bought into the organization’s mission, or do not have the skill set to contribute to that mission, are appropriately removed from the mix.  Jim Collins, renowned management consultant and author, said, “The only way to deliver to the people who are achieving is to not burden them with the people who are not achieving.” [1]

Conclusion

In conclusion, I am reminded of a speech given by legendary University of Michigan football coach Bo Schembechler.  It is simply referred to as “The Team! The Team! The Team!”  There are numerous YouTube versions of the speech.  My personal favorite is one pulled from a news clip (approximately 2 minutes long).  In his speech, Bo reminds us there is nothing in life we will achieve as an individual that will provide us more personal satisfaction than what we will achieve as a member of a team.  The team can be defined in many ways – your family, your place of worship, your work place – the list goes on.  The underlying message is this:  leaders need to provide the unwavering vision, mission, and culture necessary to make sure all stakeholders have a chance to experience the sense of team accomplishment described so powerfully in Bo’s speech.

Robert Carrera – President/CEO

[1] Good to Great:  Why Some Companies Make the Leap & Others Don’t, James C. Collins, 2001

Mar 20
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Changing Banks

Time for Your ASC to Consider Changing Banks? What You Need to Know

By ASC Governance, ASC Management No Comments

The threat of rising interest rates in the banking industry came to fruition in November 2016.  If your ASC has not taken advantage of refinancing its debt at a lower rate, your days to do so may be numbered.  Unfortunately, if the refinancing of your outstanding notes also includes a change in bank relationships, significant forethought is required to ensure the process does not negatively impact your business operations.

It is best to use a team approach to manage this process.  Team members could include administration, revenue cycle management, managed care, accounting, accounts payable, materials management, and human resources.  The process may take several months to manage safely and effectively, so plan accordingly.

First, have your team identify all aspects of your business that changing banks will impact.  Here are some areas to consider:

Accounting, Accounts Payable, & Materials Management

  • Transfer of deposits between accounts and/or lockbox
  • Current bank credit card
  • New bank credit card
  • Automatic lease payments
  • Online banking fees
  • Automatic vendor payments

Human Resources

  • Payroll
  • 401(k) withdrawals
  • HSA withdrawals
  • Automatic employee benefit provider payments

Revenue Cycle & Managed Care

  • Electronic fund transfer (EFT) payments
  • Lockbox
  • Online bill pay
  • Merchant services accounts

Next, delegate responsibilities to team members for each aspect of your business.  Responsibility and delineation of duties may look something like this:

Administration

Administration may be the best department in your organization to oversee the process.  Arrange bi-weekly calls with all stakeholders to enhance communication.  Have an agenda with specific items to accomplish before the next meeting to maintain project organization and oversight.  Prepare owners for potential disruption in cash flow. Discuss precautions, such as keeping extra cash on hand, to proactively manage worst case scenarios. 

Managed Care

Coordinate a strategy with revenue cycle management to communicate with payers about the change in payment remittance.  It may not be in your best interest to notify all payers at once that you have changed banks.  Stagger payer notifications.  When funds begin to flow through the new account from a given payer, proceed with notifying the next payer.

In advance of changing banks, and based on the schedule developed in conjunction with revenue cycle management, begin notifying key commercial payers via email the ASC’s plan to change the lockbox or EFT address.  Provide the following information based on the contract requirements:

  • The old remittance address
  • The new remittance address
  • The effective date of change – build in a 10-14 day delay between the notice and effective date
  • An updated W-9
  • Submit all information on your ASC’s letterhead as an attachment to your email notification

After you have received confirmation from each commercial payer that the new lockbox or EFT address has been loaded into their system, ask your revenue cycle management team to recommence billing.  At that time, you can begin dropping claims reflecting the new remittance address.

Revenue Cycle Management

Work with your managed care representative to develop a schedule for notifying payers of the change in bank.  Once you gain user access to the new bank account, confirm it meets your needs to perform associated collections activities.

If using a lockbox, determine the size required.  Obtain the new lockbox address.  Complete the lockbox application form, selecting documentation delivery and storage options that meet your needs.  Then, complete the automated clearing house (ACH) transfer form with your facility’s online payment vendor.

 Once you receive the new lockbox address:

  • Update the lockbox address in your patient accounting system.
  • Change the lockbox address on your electronic and/or paper statements.
  • Complete a forwarding order with the US Postal Service to the new lockbox address.
  • Obtain a copy of a voided check required to complete many EFT change forms.
  • Review current EFT payers and timing (effective date) of EFT changes.
  • Complete third-party payer applications online and via paper.
  • Monitor both accounts to confirm when EFT changes become active in the new account.
  • For payers who are not delivering payments via EFT direct deposit, complete a W-9 form and send to them with a request to correct your remittance address in their system.
  • Monitor both accounts to confirm EFTs, credit card deposits, and all other payments are moving from the old account into the new account.
  • Ensure lockbox activity at the previous bank ceases.
  • Apply for a merchant account with your new bank. Review your merchant account contract to determine how to terminate merchant services at your old bank.  Then, terminate services with the old bank to ensure credit card payments are deposited in your new account.

Human Resources

Have human resources determine which employee benefits are directly linked to your current bank account.  Armed with this information, schedule transfer of funds to your new account.  The list may include, but not be limited to, payroll disbursements, 401(k) contributions, medical/dental/vision insurance premiums, health savings and flexible spending account transactions.

Accounting, Accounts Payable & Materials Management

Accounts payable and materials management must collaborate with accounting and administration to verify bills are paid from the proper account and the account has sufficient funds.  Ensure autopay accounts are updated to reflect the new bank account information.  If a bank credit card is in use at the facility, coordinate a schedule for terminating the old card and activating the new card. 

Keep in mind your old bank account will likely remain open for six months or longer while all required transfers take place.  Bank fees will continue to be charged until the account is closed. However, following the process outlined above will assist you in timely closure of the old account and reduction in associated bank fees.

There are many reasons your ASC may find itself in a position to change bank accounts.  Managing the process for your center with forethought will not only reduce disruption to stakeholders but ensure the advantages of doing so are clear to everyone.

Pinnacle III Leadership Team

Mar 16
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Convalescent Care Center

Value Proposition: Adding a Convalescent Care Center to Your ASC

By ASC Development, ASC Governance, ASC Management, Leadership 2 Comments

If your ASC operates in a state that allows convalescent care centers, there are numerous benefits of adding one to your existing continuum of care.  We outline some of those benefits in this value proposition.  

Convalescent Center Value Proposition

In some states, an ASC may maintain a separately licensed convalescent care center as part of its service offering.  This separate licensure provides an ASC with the opportunity to keep most commercial patients beyond the standard 23-hour stay of a regularly licensed ASC.  The extended stay is granted for observation and pain control for more extensive outpatient procedures.  

The ASC is generally directly compensated for the additional recovery time in the convalescent center.  Compensation occurs in a variety of ways including hourly rates, per day rates, or increased consideration in global or bundled fee arrangements.  In addition, the ASC may be indirectly compensated by securing greater reimbursement from commercial payers on lower acuity cases.  This is because payors recognize cost savings occur when higher acuity cases safely move from a hospital to an ASC with extended stay capability.  

The primary advantage for an ASC with a licensed convalescent center is the potential to provide services to higher acuity surgical patients.  Orthopaedics and neurosurgery specialties benefit most from this advantage, specifically in total joint replacement and spinal surgery.

The types of orthopaedic cases requiring extended stay that are well-suited for an ASC connected to a convalescent care center are: 

  • Patella femoral arthroplasty
  • Total hip arthroplasty
  • Total knee arthroplasty
  • Total shoulder arthroplasty
  • Total ankle arthroplasty

These cases traditionally restricted both physicians and patients to an inpatient setting.  Although moving them to an outpatient setting represents significant savings for insurance carriers and patients alike, these higher acuity cases can provide a net revenue per case increase of 300-400% over traditional ASC orthopaedic cases.

Other types of extended stay cases well-suited for this arrangement are orthopaedic-spine and neuro-spine.  Specifically, the following:

  • Single and multi-level anterior and/or posterior cervical and lumbar fusions
  • Cervical and lumbar disc arthroplasty

Again, these spine cases may have traditionally restricted physicians and patients to inpatient settings.   Cost-savings for both insurance carriers and patients also occur when these cases move to ASCs with separately licensed convalescent centers.  The result for ASCs can be a net revenue per case increase of 600-700% over traditional orthopaedic cases and 250% above traditional spine cases.

Another advantage of these separately licensed facilities over inpatient hospitals and orthopaedic specialty hospitals occurs in payor contracting.  The value proposition for commercial payors, workers’ compensation, auto insurers, and the general public is significant.  A contracting advantage for surgeons in terms of future health care reimbursement may also be realized.  Future reimbursement will likely include, but not be limited to:  bundled payments, pay-for-performance, at risk contracting, clinically integrated networks, consumer-driven care, and price transparency.

Finally, having the capacity to accommodate higher acuity and higher paying surgical cases enhances surgeon and partner recruitment. With the saturation of “commodity” ASCs, an ASC with an adjoining convalescent care center offers the benefits of a mini-hospital. This is attractive to surgeons who may not otherwise be interested in using your facility, much less investing in it. 

What Value Does a Convalescent Center Represent for You?

Investigating convalescent care center licensure requirements in your state is a worthwhile endeavor if your facility is interested in performing higher acuity cases.  If your state allows these types of centers, conduct a thorough cost-benefit analysis to determine the feasibility of establishing one in conjunction with your ASC. 

If your state does not currently afford ASCs the opportunity to establish an adjoining convalescent center, consider these benefits, network with other facilities, then work together to rally legislative support for them in your locale.

Pinnacle III Leadership Team

Mar 10
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ASC Trends

New White Paper! Looking Ahead: 10 ASC Trends and Developments to Watch in 2017

By ASC Development, ASC Governance, ASC Management, Leadership, Payor Contracting, Revenue Cycle Management No Comments

We are excited to release our latest white paper – 10 ASC Trends and Developments to Watch in 2017.

We are still in the early months of 2017, but it is already shaping up to be an interesting year in health care — one that is likely to be a mix of uncertainties, challenges, and opportunities.

Fortunately for ASCs, they are well-positioned to thrive in the rapidly changing and evolving marketplace.  They may even be able to improve their position by planning for and effectively responding to trends and developments.

The 2017 trends and developments for ASCs identified by our leadership team include a forecast for strong industry growth, interest in adding new specialties, and continued migration of higher acuity cases to ASCs.

Changes in the relationship between ASCs and payors are impacting reimbursement especially in facilities who do not have strong revenue cycle management solutions.  Bundled payment programs and the growing number of self-insured employers continue to create marketing opportunities.

Unfortunately, the continued escalation of the financial responsibility borne by patients present revenue challenges.  And, a rise in cyberattacks has disrupted health care, bringing cybersecurity to the provider forefront.

Finally, educating patients, physicians, health systems, and payors on the value of ASCs remains a top priority. Raising this awareness is crucial to fuel the growth the ASC industry is primed to experience in 2017.

In summarizing what’s ahead in 2017 for ASCs, Trista Sandoval, our Director of Business Development & Physician Relations, said:

“One of our main strategies is to continue to focus on raising awareness of ASCs as a high-quality, low-cost option for care, and doing what we can to drive applicable outpatient cases to our ASCs. That may take the form of helping hospital systems build their own ASCs, educating patients through direct consumer marketing, or reaching out to physicians to build awareness of the ASC setting as a viable option for their procedures.”

Through such efforts, Pinnacle III’s leadership team believe ASCs will thrive in 2017.

To read the full report, download the white paper here: https://www.pinnacleiii.com/white-papers/ 

The Pinnacle III Marketing Team

Feb 01
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2016 ASC Industry Year in Review

New White Paper! 2016 ASC Industry Year in Review: 10 Key Takeaways

By ASC Development, ASC Governance, ASC Management, Leadership No Comments

We are excited to release our latest white paper – 2016 ASC Industry Year in Review: 10 Key Takeaways.

As we start the new year, it is worthwhile to examine trends and developments that helped shape the ASC industry in 2016.  These trends and developments will most likely set the tone for 2017 and beyond.

Key industry takeaways identified by our leadership include renewed focus on the migration of inpatient surgical care to outpatient settings and a surprising abundance of de novo development.

While momentum for alternative payment models stalled, the impact of implant reimbursement and increased patient financial responsibility dominated operational discussions.  Challenges presented by nursing shortages, increased regulatory compliance, and the demand for more data continued to be hot topics.

Garnering insights from these areas of focus is important given the prominent role ASCs perform in the delivery of affordable quality care.

In summarizing 2016, our Principal Partner, Rick DeHart, stated:

“From my perspective, 2016 was a transitional year for ASCs.  A significant amount of time was spent focusing on the election and anticipating its impact on the future. Everyone was waiting for much of that activity to finish . . . We may see even more activity in the industry in 2017.  Surgery centers are certainly well-positioned to be the low-cost, high-quality provider of choice for an increasing number of patients.”

To read the full report, download the white paper here: https://www.pinnacleiii.com/white-papers/

-The Pinnacle III Marketing Team

Dec 01
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Busy Professionals

Time Savers for Busy Professionals

By ASC Governance No Comments

For busy professionals, there is no doubt we live in a world where time savers feel like life savers.  Work-life balance is essential but it’s increasingly difficult to achieve.  During my tenure managing numerous surgery centers, I sought ways to make my days feel less daunting and leave feeling more accomplished at days’ end.  Here are a few tips I’ve gathered over the years to organize and save time in my daily routine:

1. Take time to start your day with a short exercise period and/or meditation.  Both activities can help you organize your day. If your mind is scattered, your day is likely to follow suit.

2. Ensure your day’s agenda and goals are realistic. Prioritize your task list to ensure you complete the most important items first.  Create a flow to your routine that allows you to smoothly transition from one item to the next.  Nothing gets accomplished if you are trying to tackle multiple projects simultaneously. 

3. As you accomplish your agenda and goals, check them off your list. Take a moment to relish your success.  You got something done – acknowledge it and let that propel you toward tackling the next item.  Crossing items off your list can be a small but significant reward for staying motivated.

4. Minimize disruptions and personal interactions by using this technique: If someone enters your office space unscheduled to chat and there is no extra time in your schedule, stand up.  This non-verbal cue signals you are involved in something or have somewhere to be.

5. Stay on task when in meetings and on conference calls. Tangents and side conversations waste valuable time.  Focus on the purpose of your meetings.  If you discover an unrelated item that warrants discussion, schedule another time to talk about it.

6. Do not procrastinate. If it’s on your daily list, do your best to complete it.  Procrastinating drains the energy you sparked from accomplishing your previous task.  Avoid losing the momentum you built.  If you continuously dive into mindless to-do items, you’ll find yourself having to complete all the important tasks you avoided at the last minute and under greater stress and anxiety.

7. Keep phone calls concise and on point. Long conversations not only create fatigue, they cost you time.  Suddenly your day got a lot shorter while your list stayed the same length.  Don’t let long phone calls throw a wrench in your routine and create unnecessary chaos.

8. Ask for help or delegate when the need arises. The onus doesn’t have to always be on you to handle everything.  If you work with a team, there is a reason you call them teammates.

9. Take time out for yourself. This may be a 10 or 15 minute break to get your mind off the work you are doing and rejuvenate. These little breaks can go a long way to help your mind reset and refocus.

10. Move unaccomplished items to the next day’s agenda. It won’t always be possible to tackle everything on your daily to-do list. Don’t push yourself to the limits for the sole purpose of crossing them off.  Sometimes it’s just not worth it.

11. Create your next day’s agenda and action plan before leaving work. Just like a football team studies before a game, get ready for tomorrow by figuring out your action plan ahead of time. This will allow to enter your office ready to go when you arrive in the morning.

12. Stay hydrated. This is not a time saver, but helps with clear thinking and prevents fatigue. Taking care of your body is crucial to your ability to attend to tasks while not draining yourself in the process. Your health should always come first!

These tips can lead to an easier-to-manage routine that should help you be – and feel – more productive.  Being productive does not equate to constant fatigue.  These adjustments take time but will go a long way toward helping you feel energized.  Busy professionals should feel accomplished at the end of the day.  Hopefully these tips help get you there!

Rick DeHart – Principal Partner

Nov 17
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ASC Tax Strategy

Administrators: Consider Cost Segregation as an ASC Tax Strategy

By ASC Governance No Comments

Investigating cost segregation of your depreciable assets may serve your surgery center well.  This ASC tax strategy could allow you to reduce your tax burden and improve your cash flow by shortening your depreciable tax life with acceleration methods. 

How it works

Typically, nonresidential real property assets are given a tax life of 39 years.1 A qualified asset management team can investigate and re-engineer those depreciable assets to three, five, seven or even a fifteen year tax life – all of which are allowable under the IRS tax code.  The good news is that this process is not confined to new property or assets.  As long as the assets have not been fully depreciated, there still may be value to cost segregation.

Basic principle

The basic principle is based on today’s dollar which is assumed to have more value than the future dollar.  Accelerating depreciation increases your tax deduction today – an approach that allows you to take advantage of the better dollar value.

Who does it?

Seek out the services of a cost segregation team and ask them to develop a proposal for your ASC.  According to the IRS, “The preparation of cost segregation studies requires knowledge of both the construction process and the tax law involving property classifications for depreciation purposes.  A preparer’s credentials and level of expertise may have a bearing on the overall accuracy and quality of a study.  In general, a study by a construction engineer is more reliable than one conducted by someone with no engineering or construction background.  However, the possession of specific construction knowledge is not the only criterion.  Experience in cost estimating and allocation, as well as knowledge of the applicable law, are other important criteria.  A quality study identifies the preparer and always references his/her credentials, experience and expertise in the cost segregation area.”2

Many of the larger accounting firms and standalone consulting firms have cost segregation teams that are qualified to complete your re-engineering cost analysis.

Cost

The fees associated with a cost segregation study can be expensive.  Reputable firms will prepare a cost versus return on investment (ROI) analysis for you to review before you commit.  With the political environment subject to change, it may be worth investigating this strategy sooner rather than later.

Conclusion

If your ASC is interested in improving its cash flow through reduction of federal and state income taxes, it may behoove you to investigate cost segregation as a potential strategy.    

Rick DeHart – Principal Partner

1 https://www.irs.gov/publications/p946/ch04.html

2 https://www.irs.gov/businesses/cost-segregation-audit-technique-guide-chapter-4-principal-elements-of-a-quality-cost-segregation-study-and-report

Sep 02
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What Does It Take to Run an Effective ASC Board Meeting?

By ASC Governance No Comments

We sat down with Rick DeHart, Principal Partner for Pinnacle III, to gain some advice on what it takes it run an effective ASC board meeting. Rick enlightened us with his 25 years of experience in the ASC industry managing governing boards and running effective meetings. Here is what he had to say:

  1. Preparation is key. Create a detailed, organized agenda that covers the appropriate items needed for board approval and/or discussion. Thoroughly understand your presentation items, such as monthly and quarterly financials. Anticipate questions from stakeholders.  Be prepared to clearly respond with clarifying information.  Conduct a detailed review ahead of time with your team to ensure everyone is familiar with the information that will be presented.                                                                                                                                                                                                    
  2. Send out the agenda in advance. Once the agenda has been created, it is important to distribute it to board members at least 24-48 hours prior to the meeting. This allows everyone time to review the information and/or request additions or changes.                                                                                                                                                                                                                                                
  3. Be organized. Make the best use of the limited time you have available with your board members.  As the leader of the meeting, organizing meeting items appropriately will allow you to cover everything on the agenda and allow for discussion that will lead to sound decisions. Sequence materials in a fashion that is easy to find; avoid putting together packets of information that send everyone scrambling to find their place.                                                              
  4. Stay on task. You will have approximately 90 minutes at most before people lose interest. If possible, consider scheduling meetings for an 1 ½ hours or less.  Keep questions defined and answers focused. Take questions at the end of each agenda item before moving on to the next section.  Restrain yourself and meeting participants as much as possible to ensure you do not go off on tangents!                                                                                                                                             
  5. There will be times when you cannot answer certain questions in the meeting or need to research items further. In those cases, follow up with an email to board attendees noting you are looking into those questions and will provide answers in the near future.  If you are not prepared to respond with meaningful information, don’t wing it!  It’s better to delay a response to ensure it is correct, rather than provide an immediate response that is poorly articulated or, even worse, contains inaccurate information.                                                                                             
  6. Debrief with your team following the meeting. Decide on appropriate next steps and determine if further research is needed to handle unaddressed inquiries.  Assign follow-up items to the appropriate team-members. Keep an eye on whether or not follow-up items are being handled in a timely fashion.  Don’t over-manage the process but be available to step in when necessary.

Feel free to contact Rick for more advice on managing an effective governing board meeting or anything else related to running your ASC: rdehart@pinnacleiii.com.